Wednesday, July 6, 2016

At third and final Medicaid hearing, Eastern Kentucky residents say plan doesn't match up with the realities of their region

By Al Cross
Kentucky Health News

In the county and region where the expansion of Medicaid has had the most impact, residents and health-care providers gave the harshest criticism yet of Gov. Matt Bevin's plan to change it.

"Poor people don't need more red tape and hoops to jump through," Elizabeth Hensley of Clay County told state officials near the end of the Wednesday hearing that drew about 150 people to Hazard Community and Technical College.

Hensley contended that the plan, which would impose premiums on Medicaid members and work-oriented rules on most able-bodied members, is designed to limit usage of the program -- a goal that will leave some people without the care they need.

"The Bevin administration is obviously out of touch with the poor and people who live in poverty," Hensley said. "Poor people pay taxes too," such as sales and payroll taxes. "We are already taxed to death. This waiver will just make that literal. We know this governor doesn't care about us."

Health and Family Services Secretary Vickie Glisson didn't reply to that charge but said all the comments would be considered as the state amends its plan for submission to federal officials, requesting a waiver from standard Medicaid rules.

Whitesburg dental hygenist Pam Cornett,
a member of the Kentucky Oral Health
, said dental benefits should be in
basic coverage. (Image from WYMT-TV)
Several speakers objected to the proposal to remove dental and vision benefits from basic Medicaid coverage. Those services could be earned through a rewards program, but Mary McKenzie, director of a Hazard-based mental-health clinic, said, "To say you must earn what is a basic right, what most of us take for granted, is very insulting."

Dr. Lisa Triplett Short, a Hindman dentist, said many people covered by the expansion got dental care that "allowed them to be more cofident, to go out and seek employment."

State Rep. Fitz Steele, a Democrat from Hazard, said in written comments read into the record that annual dental and vision exams are "inexpensive tests [that] provide vital front-line diagnostics," and said hearing aids should also be included: "If you can't hear, you can't learn or work."

State Sen. Brandon Smith, a Hazard Republican, took no public position on the plan but was among those who thanked Glisson for holding a hearing in Perry County, where 19.1 percent of the population is covered by then-Gov. Steve Beshear's 2014 expansion of Medicaid eligibility. That is the highest rate of any county.

Serena Owen of Northern Kentucky submitted a petition calling for hearings in that region, Louisville and Paducah "to give Kentuckians more of a voice." Earlier hearings were held in Bowling Green and Frankfort; federal rules require two hearings but don't prohibit more.

State Rep. Joni Jenkins, D-Shively, traveled from her Louisville-area district to suggest that Bevin involve House members and senators from both parties in discussions to draft a compromise plan that would not use children, seniors, veterans and other vunerable people "as pawns in a political chess game."

Hensley claimed that Bevin knows federal officials won't accept the plan. Others have said likewise, citing the proposal that able-bodied adults who aren't primary caregivers be required to have a job, look for one, take job training or do a certain amount of volunteer work.

"I'm concerned about the oxymoron, mandatory volunteerism," said Michael Wynn of Grace Health in Knox County.

Andrea Bush of Hazard said the rule would lead to "unintended consequences" for people who don't have checking accounts or stable addresses.

Jason Bailey of the Berea-based Kentucky Center for Economic Policy said the plan is "based on the assumption that poor behavior choices has led to a high percentage of people covered by Medicaid," which he said is incorrect.

Bailey said most people in the expansion work, but mostly at low-wage jobs that don't offer health benefits. He said only 56 percent of Kentucky workers get coverage at work, down from 70 percent in the 1980s, and only 28 of the 120 counties "have more people employed today than when the recession hit. . . . That's not because of a sudden unwillingness to work."

Bailey said he fears that the plan "will worsen many of our challenges. . . . "Medicaid is a safety net program that provides a lifeline. Reducing its reach will only make problems deeper."

Some speakers endorsed the proposal to have Medicaid pay for 30 days of inpatient treatment for substance abuse, and its retention of current behavioral-health benefits.

But behavioral-health advocate Sheila Schuster of Louisville said the mentally disabled and others deemed to me "medically frail" shouldn't be required to pay premiums. She said most don't have a checking account, don't open their mail and often don't have stable addresses or guardians. "I beg you, I beg you" to exempt them, she beseeched Glisson.

Schuster said the move on dental and vision benefits "makes absolutely no sense," and the plan to raise premiums on people above the federal poverty line is "simply a penalty imposed for being poor."

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